When a colleague has an accident or ends up in hospital, there are two bad scripts inside a company: nobody knows what to do – or everybody wants to take charge. This template process sets down the third way: everyone knows their own role exactly, and the case moves along the fastest route.
The template process in five steps
- The colleague signals. The insured (or, in bigger trouble, a family member) tells their manager or HR: something has happened that may involve the cover. That is the whole first step – they do not need to know any rules.
- HR hands over the insurer contact sheet. A one-page internal aid: the insurer's claim channels, the policy number, and the list of typically requested documents. It is worth putting this sheet together at rollout; a good basis for its content is the document list by event type.
- The entitled person files – on the insurer's channel. The claim is filed by the entitled person, typically on an online portal or with the insurer's customer service. Neither HR nor the broker files in their place: the medical documents move between the entitled person and the insurer, and the employer never sees them. The detailed route is in the article on filing a claim with the insurer.
- Status tracking. The entitled person watches the insurer's responses and replies quickly to requests for missing documents; HR's part is to check in from time to time: "moving along? need any help?"
- If it stalls or is disputed: help from the broker. A routine case is fastest on the insurer's own channel. But if the case stalls, or the claim is disputed, as a broker I help the client, where I can – that is the moment to call me in, not sooner and not after the fact.
Responsibility matrix template
| Step | Responsible | HR's role |
|---|---|---|
| 1. Signal | colleague / family member | receives the signal, with empathy |
| 2. Handing over the contact sheet | HR | hands it over, explains it briefly |
| 3. Filing with the insurer | entitled person (insured / beneficiary) | takes no part in it |
| 4. Status tracking, follow-up documents | entitled person | checks in, encourages |
| 5. Stalled / disputed case | broker (helping the client) | signals to me that the case has stalled |
The point of the matrix is row 3: filing is a matter between the entitled person and the insurer. The employer's role – support, don't take over – has its own article: employer tasks in a claim.
How to roll this process out
Three things are needed: the contact sheet (the aids on the Resources page give reference points for it), a short employee notice – you will find ready-made text in the employee announcement template – and a named HR contact. Review the process once a year, in the renewal round: contact details, policy number, contact person – three minutes and it is up to date.
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